ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00667.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Over the years three different concepts regarding the cure of treated breast cancer have emerged. These are clinical cure, personal cure and statistical cure. The latter is the most accurate estimate of the curability of a disease which is presumed to be fatal unless treated. Statistical cure is the elimination of the hazard of death in a treated group compared with an age‐matched control population. When statistical cure is studied in patients treated for early breast cancer, it is clear that breast cancer is an incurable disease. The expected gains from the relatively recent introduction of adjuvant therapy are too small to alter this concept. The significance of prognostic factors in a disease deemed to be incurable therefore requires re‐examination. The conventional prognostic factors of tumour size, nodal status and a combination of those two in staging systems significantly discriminates in terms of survival in the short term. However, when the characteristics of long‐term survivors are examined, neither tumour size nor nodal status discriminates effectively. If this is the case, then we need to reconsider novel treatment strategies which have been introduced in the hope of increasing the curability of the disease and the selection for those treatment strategies of patients using the conventional prognostic factors of tumour size or nodal involv

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00668.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A retrospective study was made of the presentation of breast cancer in Chinese women who were treated at the University Surgical Unit, Hong Kong, over a 20 year period (1971–90). Only 6% of patients presented with tumours less than 2 cm. Nearly half the patients presented with advanced disease. There was no tendency towards earlier presentation in the latter half of the study period. An increase in the number of patients treated for breast cancer was observed; the increase being seen mainly in postmenopausal wome

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00669.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Results of renal transplantation in very young children with end‐stage chronic renal failure have been poor compared with those in older children and adults. Consequently small children either may not be treated or may be placed on chronic dialysis programmes. Between 1988 and 1992, six children under the age of 5 years received seven renal transplants at the Royal Children's Hospital, Parkville, Victoria, Australia; five from live donors and two from cadaver donors. All children were treated with peritoneal dialysis before transplantation, and immunosuppressed with a standardized regimen of cyclosporine, azathioprine and prednisolone. An extraperitoneal incision was used, and the donor renal vessels were anastomosed to the lower abdominal aorta and inferior vena cava or the common iliac vein. All children received intensive monitoring and fluid replacement during the peri‐operative period. Patient survival was 100%. One cadaver graft failed 1 week after transplantation because of irreversible acute rejection. This child subsequently received a successful second transplant. Two children developed postoperative urinary fistulae which were treated successfully by further operation. Current renal function in all children is excellent. The success of this programme has led us to review our attitude towards renal transplantation in this age group and to advocate live donor renal transplantation as the treatment of choice in very young children with end‐stage chronic renal failure whenever pos

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00670.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The endoscopic injection of Polytef paste is now a well established method of treating vesico‐ureteric reflux. In this study the video tapes of 64 treatments were independently reviewed to assess any predictors of failure. The visual appearance of the mound of paste was found to correlate with the clinical outcome, except when less than 0.2 mL of paste was used for smaller ureteric orifices, or when the ureteric orifice was large enough to admit the 9.3 FG cystoscope. In cases with a large ureteric orifice effective treatment was achieved without the neat crescent‐on‐a‐mound appearance, provided a larger than average volume of paste was used. Meticulous placement of the needle was also shown to be important if success was to be

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00671.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A retrospective review of 80 patients who underwent scrotal exploration for presumed testicular torsion is presented. Of these, 67 patients were found to have torsion, and the testicular loss rate was 51%. Patients who experienced delays in scrotal exploration of more than 24 h from onset of symptoms had a testicular loss rate of 71 %. These delays arose from both hesitation in seeking medical treatment and misdiagnoses. It is emphasized that an acute scrotum in a child or in an adolescent should be explored early to exclude torsion.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00672.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This is a review of hypospadias surgery in a provincial surgical practice over 18 years. A total of 347 boys were seen with hypospadias, of whom 209 were operated upon. These operations consisted of 69 Durham Smith de‐epithelialized double‐breasting two‐stage procedures, 45 meatal advancement and glanuloplasty procedures, 27 hemi‐circumcisions with or without meatotomy, 24 single stage repairs for distal hypospadias without chordee, 23 operations for chordee without hypospadias. 15 modified Mathieu single stage procedures and six miscellaneous procedures. The complication rate, particularly for fistulae formation in 17%, was unacceptably high. Some causes of fistulae were identified; these included delayed absorption of chromic catgut sutures and stitch abscess. Stricture occurred less frequently, but one case was severe enough to require complete revision of the urethroplasty. In early operations a coronal meatus was the norm and six patients required advancement pro

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00673.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A retrospective study was carried out to evaluate the outcome following laryngotracheal reconstruction (LTR) performed in 15 children for the treatment of severe laryngotracheal stenosis between 1989 and 1993. The age ranged from 18 months to 19 years with all but one patient being tracheostomy‐dependent. The trdcheostomy tube was successfully removed in 12 children who remain free of obstructive symptoms at follow up. One patient was successfully decannulated but required repeat tracheostomy 8 months later for intermittent severe supraglotticlpharyngeal obstruction. There were two failures, with one of these undergoing repeat LTR with successful decannulation. Surgery was complicated in one child by aspiration which improved spontaneously. These findings suggest that LTR is a safe and effective procedure for the management of severe paediatric laryngotracheal stenosi

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00674.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Over an 8 year period, 117 renal transplants (97 cadaveric and 20 living related) were performed at the Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. Ureteric complications following renal transplantation occurred following seven transplants (6%). The technique of using a multiply fenestrated vesicocutaneous stent/drain to manage this problem is described. This was uncomplicated in all cases with the exception of one case in which the stenvdrain was removed early because of blockage and sepsis, but most importantly on no occasion was the graft lost. We therefore recommend this technique for the management of this complication, whether early or late. We observed a disproportionate number of ureteric complications in living related transplants, a feature not described previously.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00675.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This study was performed to assess the early results of treating stages T1‐T3 adenocarcinoma prostate with either Iodine‐125 (125I) implant alone (Group 1), for smaller more well differentiated cancers, or with low dose external beam radiation followed by a125I boost (XRT +125I) (Group 2) for larger less well differentiated tumours. Eighty‐six patients were followed for between 11 and 60 months with a mean follow up of 26.1. All patients were followed by regular prostate specific antigen (PSA) evaluations, and digital rectal examinations (DRE). Eighty patients had a follow‐up biopsy at 1 year. Prostate specific antigen progression‐free survival (PSA‐PFS) was determined and defined. Complications and potency were also assessed. Early results of125I prostate seed implantation are very promising especially for selected cases of localize

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1995.tb00676.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY